Experts Highlight Therapeutic Drug Monitoring in Fight Against Antibiotic Resistance

Padang (ANTARA) - As antimicrobial resistance (AMR) continues to threaten global health, experts say optimizing the use of existing antibiotics is becoming just as important as developing new ones. One increasingly important strategy is Therapeutic Drug Monitoring (TDM), which helps ensure that antibiotic doses are both effective and safe for individual patients.

Although inappropriate prescribing and incomplete antibiotic courses remain major drivers of resistance, inadequate antibiotic exposure also contributes to the problem. Drug concentrations below therapeutic targets may fail to eradicate bacteria completely, allowing resistant strains to emerge, while excessive concentrations increase the risk of toxicity without improving treatment outcomes.

Vancomycin, a life-saving antibiotic used to treat severe infections caused by methicillin-resistant Staphylococcus aureus (MRSA), exemplifies this challenge. Because it has a narrow therapeutic window, clinicians must carefully balance efficacy and safety. TDM enables healthcare professionals to measure antibiotic concentrations in a patient's bloodstream and adjust doses according to individual pharmacokinetic characteristics rather than relying solely on standard dosing recommendations.

Recent advances in Bayesian pharmacokinetic modelling have further strengthened the role of TDM. By integrating laboratory drug concentrations with patient characteristics such as kidney function, age, body weight, and previous drug exposure, Bayesian software supports Model-Informed Precision Dosing (MIPD), enabling clinicians to make faster and more accurate dosing decisions for critically ill patients.

Experts emphasize that Therapeutic Drug Monitoring (TDM) is more than a laboratory measurement; its true value lies in expert clinical interpretation. Effective implementation requires close collaboration between clinical pharmacology physicians and other healthcare professionals to integrate drug concentration data with patient-specific factors, including clinical condition, organ function, comorbidities, and concomitant medications. Based on this comprehensive assessment, individualized antibiotic dosing recommendations can be provided to optimize treatment outcomes. This multidisciplinary approach improves therapeutic efficacy, minimizes the risk of drug toxicity, supports antimicrobial stewardship, and helps reduce the emergence of antimicrobial resistance.

Recognizing the growing importance of TDM in combating antimicrobial resistance, researchers from the Faculty of Medicine, Universitas Andalas, are collaborating with Believers Church Medical College Hospital (BCMCH), Kerala, and Christian Medical College (CMC) Vellore, India. The collaboration focuses on strengthening Indonesia's capacity in therapeutic drug monitoring through laboratory development, pharmacokinetic/pharmacodynamic (PK/PD) data generation, harmonization of analytical methods, and Bayesian precision dosing.

As part of the collaboration, the Indonesian research team will participate in scientific training in India covering standardized TDM procedures, pharmacometric modelling, PK/PD interpretation, and joint development of Bayesian population pharmacokinetic models. The program also includes knowledge exchange, joint scientific publications, and development of precision dosing strategies tailored to Indonesian patients.

According to principal investigator Dr. dr. Gestina Aliska, Sp.FK, the collaboration brings together researchers from Indonesia and India to address shared challenges in optimizing antibiotic therapy and implementing precision medicine.

“This collaboration is not only about producing scientific publications. It is about strengthening Indonesia's capacity in therapeutic drug monitoring, pharmacometrics, and precision medicine so that antibiotic therapy becomes safer, more effective, and more rational,” she said.

The project is expected to generate Indonesian population-specific pharmacokinetic data, externally validate Bayesian dosing models, and support wider implementation of Model-Informed Precision Dosing in Indonesian hospitals. Researchers hope the initiative will strengthen antimicrobial stewardship programs and help preserve the effectiveness of life-saving antibiotics.

As antimicrobial resistance continues to rise worldwide, experts believe preserving the effectiveness of existing antibiotics is becoming as important as developing new ones. Wider implementation of Therapeutic Drug Monitoring supported by clinical pharmacology physicians, precision medicine, and pharmacometric modelling, offers a practical strategy to improve patient outcomes, reduce drug toxicity, and slow the emergence of antimicrobial resistance.